Urology Coding Alert

Question: My surgeon preformed a laparoscopic radical nephrectomy on a horseshoe kidney but could not finish dividing the isthmus, so he extended a port incision and finished the division open.  Is it appropriate to code the open radical nephrectomy in addition to the symphysiotomy? Should the symphysiotomy be captured with modifier 22 or should this be 50545 with 50540?

Ohio Subscriber

Answer: You are partially correct. Since this operative scenario represents an initial laparoscopic procedure converted to an open procedure to complete the proposed surgery, it would be most appropriate to code the open procedures:

• 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) for the open radical nephrectomy
• 50540 (Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other plastic procedure, unilateral or bilateral [1 operation]) for the open symphysiotomy.

Likely diagnoses would include 189.0 (Malignant neoplasm of kidney ...) or 753.3 (Other specific congenital anomalies of kidney) for the horseshoe kidney, and V64.41 (Laparoscopic surgical procedure converted to open procedure).